Air Pollution and Emergency Department Visits for Disease of the Genitourinary System

The aim of this study is to determine associations between ambient air pollution and the number of emergency department (ED) visits for diseases of the genitourinary tract in Toronto, Canada. We used the National Ambulatory Care Reporting System (NACRS) database to obtain the related ED visits and developed statistical models using daily data on ED visits, temperature, relative humidity, and outdoor air pollution concentration levels. The NACRS database contains data on hospital-based and community-based ambulatory care. The environmental data were retrieved from the National Air Pollution Surveillance (NAPS) program. The NAPS is the main source of ambient air quality data in Canada. We considered 2 air quality health indexes and 6 air pollutants: daily means of fine particulate matter PM2.5, O3, CO, NO2, SO2, and also maximum 8-hour average ozone. For every air pollutant, we fit 270 models (15 lags × 18 strata). We found that same-day air pollution concentrations have the highest number of statistically significantly positive associations with ED visits for genitourinary health outcomes. A total of 133 positive associations were identified over the 14 days lag. In subgroup (strata) analysis, females older than 60 years of age were found to have the most positive associations. In particular, nitrogen dioxide was found to be highly associated with ED visits for females over 60; an increase in NO2 was associated with an increased relative risk (RR) of ED visits when lagged over 0, 1, and 2 days (RR = 1.040 [95% confidence interval: 1.028, 1.052], 1.020 [1.009, 1.032], and 1.025 [1.013, 1.036], respectively). The values of risks are reported for a 1 interquartile range increase in concentration (8.8 ppb). Our results suggest that urban ambient air pollution affect the number of ED visits due to genitourinary system conditions.